The Impact of Dapagliflozin on Cardiac LV Systolic function in patients with ST Elevation Myocardial Infarction undergoing Primary Percutaneous Coronary Intervention who developed Post MI LV Dysfunction

Abstract

W orldwide, ischemic heart disease is the single most common cause of death and its frequency is increasing. STEMI is a significant cause of morbidity and mortality in patients with coronary heart disease. PCI is considered to be the preferred reperfusion strategy for acute coronary syndrome (ACS). Despite optimal evidence-based PCI, MI remains the most common cause of heart failure. Dapagliflozin [Farxiga® (USA); Forxiga® (EU)], a sodium–glucose cotransporter 2 (SGLT2) inhibitor, was recently approved in the USA and the EU for the treatment of adults with symptomatic heart failure with reduced ejection fraction (HFrEF). However, there are no published randomised trials evaluating the effects of SGLT2 inhibitors on LV function in the immediate post-ACS period. Our study aimed to evaluate the impact of dapagliflozin on LV systolic function in patients with ST Elevation Myocardial Infarction undergoing primary percutaneous Coronary Intervention who developed post MI LV dysfunction regardless their diabetic status versus placebo. It was conducted as an interventional randomized controlled clinical trial, including 40 STEMI patients who have undergone primary PCI and received 10 mg of dapagliflozin for 3 months (Group A). While the control group included 40 STEMI patients who have undergone primary PCI who did not receive dapagliflozin (Group B). Our study found a significant improvement in LV systolic function, whereby dapagliflozin treatment was associated with an improvement of LVEF compared with the control group We found that there is a major relationship between dapagliflozin treatment and changes in LV systolic function. There was a significant statistical difference between both groups regarding follow-up EF with mean range of 45.36%±7.13 in the case group and 41.80%±6.93 in the control group (P=0.027). Results for age, gender, hypertension, smoking, family history dyslipidemia, and diabetes did not show any statistical significance of value between the cases and control groups. In summary, our study concluded that dapagliflozin given to post-STEMI patients with LV dysfunction improved their LV systolic function and LVEF compared to placebo. Based on the results of this study, we highly recommend the routine use of dapagliflozin 10 mg once daily in patients presenting with STEMI induced LV dysfunction.